Pills for Cheap

Case 1

A grossly obese 41 year old male was admitted to hospital for knee surgery. He lived alone in a small unit, was unemployed, had no interest in outdoor activities or hobbies and had very poor dietary habits. At 180 Kg, with high blood pressure and a failing heart he was not a good candidate for anesthesia. It was decided to seek the opinion of a respiratory specialist when nursing staff and fellow inpatients complained of his loud and unrestrained snoring and it was with obvious relief that he was transferred to the sleep unit. Overnight studies demonstrated severe sleep apnoea with both obstructive and central components. He was fitted with a nasal CPAP mask which greatly improved his nocturnal oxygenation but surgery was still considered too great a risk for such a patient. He was advised to continue nasal CPAP at night for the remainder of his time in hospital to familiarize himself with the procedure for home use. He was discharged from hospital following a thorough assessment of his heart disease and blood pressure, and placed on a strict weight reduction diet. The man was seen a month later in an outpatient clinic. He had reverted to his previous eating habits, put back on the small amount of weight lost during hospitalization and had discontinued the use of CPAP. He could not be convinced of its benefits and remains untreated for this serious condition.

Comment: An unmotivated patient with this sort of medical history can only expect further deterioration. It takes some time to become accustomed to CPAP, but failing that there should at least be an urgent reappraisal of one’s lifestyle.

Case 1

After many years of recurring tonsillitis in a 7 year old girl, her parents had reached the point of desperation. This first manifested itself as snoring when the child was about 18 months old but a pediatrician assured the parents that the young girl would eventually grow into her large tonsils. Sleep related snoring and occasional episodes of tonsillitis marked the early years of her life until she was 4 years old when her mother became aware of times when the child seemed to be struggling for breath. In retrospect, judging by a description of events in the following years, the child had developed OSA, the consequences of which were to disrupt the life of parents and child for a further three years. Severity of the child’s airway obstruction no doubt reflected the status of the child’s tonsils. At best there was always a degree of snoring but a common cold or any inflammation of her tonsils would guarantee a succession of traumatic nights; traumatic for the child who would awake several times a night crying and further complicated by instances of bed-wetting and falling out of bed. It was also traumatic for the parents who were anxious about their daughter’s distress at night, not to mention the considerable disruption to their own sleep. Antibiotics probably helped to minimize the duration of these episodes but it was becoming increasingly clear that prescription of these medications was not addressing the underlying problem.

For a girl of above average ability, she was not progressing as well as could be expected and frustrated teachers would report on her tiredness and lack of application. The parents finally sought help from a pediatrician with some expertise in sleep apnoea. A hospital admission and overnight studies documented airway obstruction and oxygen desaturation consistent with OSA. Tonsils and adenoids were surgically removed a month later and the results were immediately apparent. Snoring was virtually abolished and her parents no longer had to comfort a distressed child at night, indicating an improvement in sleep quality and although she still experiences occasional colds and upper respiratory tract infections, heavy snoring and complete airway obstruction has never reoccurred.

Comment: Disruption of home and school life could have been avoided with earlier detection of OSA.

*16/51/5*

Preventive medicine can be divided into three categories.

Primary prevention involves the removal of causes so that the condition doesn’t occur in the first place. Diseases related to smoking are obvious examples here: stop people smoking (primary prevention) and the smoking-related diseases disappear.

Secondary prevention picks up disease before symptoms occur. This is the essence of health screening which, by detecting disease early, can prevent the development of more serious manifestations of the disease. Detecting previously undiagnosed high blood pressure is a good example of this kind of prevention.

Tertiary prevention involves the management of diagnosed disease in such a way as to prevent or limit the development of a disability or to prevent the person dying prematurely. The best example here is diabetes. Diabetics with good tertiary prevention can now live long and near-normal lives.

But what are we aiming for with all the prevention-eternal life? No. Most people, when asked, are happy to settle for a reasonably long lifespan spent in good health. In simple terms medicine over the last hundred years or so has shifted deaths in early years to later life. However, despite a four-fold increase over the last century in the number of men living to be 100 and a nine-fold increase in the number of women living to that age, the proportion is still only one in 1,000 and 5 in 100 respectively. Suggestions that we could all live to 130 or more are as yet somewhat fanciful but we can now reasonably aim to live to about 85 or 90, with few of us dying of disease under the age of 70. If we are to achieve this we have to attack cancers and heart disease, which account for more than half of all life lost under the age of 85, and those few diseases that stand out as special cases. These include diseases associated with the excessive use of alcohol, addictive drugs, motorcycles, cigarette smoking in women and large numbers of sexual partners.

But being healthy is not just a matter of what you do or do not do. It seems that health and long life are often a gift bestowed on a person at conception when they inherit good genes. With the combined effects of healthy habits and good luck many people’s health can be maintained for years with good medical care taking the edge off diseases and accidents. Until fairly recently, living longer usually meant accumulating more and more disorders, diseases and disabilities which, together with social isolation, poverty, failing memory, a loss of purpose, reduced family contacts and other limitations, have led to a vast increase in the numbers of elderly people living out the last years of their lives in residential care. Younger people, seeing this as a depressing future for themselves, are beginning to get concerned-and rightly so. A questionnaire in a Swedish magazine in 1971 asked readers how they most wanted to did A large majority said they wanted to pass away quickly and without worrying. So, ironically, what we are all trying so desperately to prevent-heart disease – appears to be exactly what, in one form, many of those ‘at risk’ most want to die from. But as in the old monk’s prayer-’Dear Lord, give me patience; but give it to me now’-we can’t choose when this sudden and quick form of death will take us. None of us would mind dying like this in our seventies or eighties but the tragedy is that increasing numbers of men in their forties or fifties are losing their lives in this way.

Some people worry about the long-term effects of a population with an ever increasing proportion of ever older people, and they have a point which has to be taken seriously by those who try to prolong life at almost any price. Viewed in the widest possible socio-economic perspective, the gradual move from a three-generation society to a four-generation one is likely to produce increasing strain between the productive and reproductive groups and those who are mainly ‘takers’ from society. Our industrial society cannot find enough jobs for its working-age people, let alone the elderly. So we could soon see countless millions of pensioners in the western world with many years of life to live but with nothing to do.

No one would dispute the benefits preventive medicine has brought in the earliest part of life but, some people are asking, should it be allowed to do the same for the other end of the life scale – at least in those societies where already those who reach middle age tend to live into their eighties? All of this may appear somewhat pessimistic but it could well be that within the reasonably near future the elderly will be taking up so much of the nation’s resources that curative medicine for the productive sector of society will be seriously put at risk. There are those who would say that this is already happening, at least to some extent.

*16/72/5*

Remember when you were a kid and you brought home an excellent report card? You knew that your high grades would earn praise from your parents, and you looked forward to hearing what a good student you were. The quarters that you’d get from Grandpa weren’t bad, either.

All of us like to be recognized for what we do well. This is just as true when we’re trying to lose weight as when we earned an “A” in arithmetic.

Some of the most memorable rewards that you receive will come from others. But even more important are the rewards that you give yourself.

Remember the first commandment, “Believe in yourself”? When you acknowledge each weight-loss goal that you have achieved, you are honoring the commitment and hard work that you’ve put into creating a new, healthier life for yourself. You don’t have to wait for the big, “I-lost-75-pounds!” sorts of goals, either. Something as small as adding an extra mile to your daily walk or not eating french fries for a week can be cause for celebration.

So go ahead! Take a half-day off from work. Go shopping. Get a manicure. Buy tickets to the Yankees game. Do something that you really love but don’t usually make the time to do.

When you reward yourself for a job well-done, you reinforce your belief in yourself and tell yourself that you’re proud of what you’ve accomplished. It makes you want to do more, to see how far you can go. And that’s what living life to the fullest is all about.

*10\89\8*

The main sources of yeast are bread, stock cubes and Bovril, yeast extract (Marmite, Vegemite etc), and alcoholic drinks.

Soda bread and chappattis are good substitutes for yeast-leavened bread. Soda bread is made using baking powder.

Stock cubes are very difficult to replace, and stews and casseroles do taste rather insipid without them, although your taste-buds adapt to this eventually. If you have the time, you can make your own stock using bones and waste meat, or the remains of a roast chicken for poultry stock. Add some bay leaves or other herbs, and boil for about 20 minutes, in a pressure cooker preferably. Skim off the fat when cold, remove the bones, and then add salt to taste. The stock can be frozen for future use.

When cooking beef casseroles, try frying the beef thoroughly before stewing it, making sure all the juices in the frying pan are subsequently transferred to the casserole. This creates a rich meaty taste, which can be enhanced by adding thoroughly browned onions.

The only ‘instant’ yeast-free stock is a vegetable bouillon mix sold as a powder or a paste. It is obtainable in some healthfood shops or by post. The paste can also be used as a substitute for Marmite.

Toasted sesame seeds (spread them on tinfoil and toast under the grill using a low heat) or toasted sesame-seed oil (available at shops selling macrobiotic food) can also be used to give a stock-like flavour to casseroles, but be careful not to eat too much sesame.

*405\180\8*

Allowed:

Lamb, turkey, pork, duck, goose, rabbit (all fresh and unprocessed)

Any fresh vegetables

Potatoes

Rice, unless you usually eat this often

Any fresh fruit, other than citrus fruit (oranges, lemons etc), pineapple and papaya

Chickpeas; also beans and lentils (but not if you have bowel symptoms) Any nuts that you do not normally eat very often Herb teas, except mate and redbush Pure vegetable oil

Not allowed:

Bread

Wheat, rye, barley, oats, maize (corn, sweetcorn etc)

Rice, if you eat this regularly

Beef and chicken

Milk, butter, yoghurt and cheese

Margarine

Eggs

Pineapple and papaya

Oranges, lemons, grapefruit etc

Marmite and other yeast extracts

Oxo cubes, other stock cubes, Bovril etc

Mushrooms

Peanuts

Anything you normally eat every day or crave Any suspect food

Coffee, chocolate, tea (including green tea, jasmine tea etc), cola drinks Sugar, any sugar-containing foods, and artificial sweeteners All additives

All alcoholic drinks, and their derivatives Vinegar and pickles

Bacon, ham, corned beef and all other smoked or processed meats Curries and other very spicy foods Aspirin and related drugs

*358\180\8*

The main one, in our view, is the increasing exposure to man-made chemicals – food additives, pesticide residues, exhaust fumes, solvents, industrial pollutants and the like. It is known (although only from case-histories) that a single massive exposure to a toxic chemical, such as a pesticide, can bring on a severe form of food intolerance. It is also the case that a small proportion of people with food intolerance are unduly sensitive to everyday chemicals. What is more, if those people can reduce their chemical exposure, they often find they can tolerate the foods to which they are sensitive normally. It seems likely that these people have certain enzyme deficiencies, which make them vulnerable to man-made chemicals and intolerant of certain foods – but if the chemical stress can be reduced they are able to cope adequately with those same foodstuffs. Such people would not have been ill if they had lived 50 years or more ago, but they are ill now, because the environment around them has changed.

Environmental chemicals could also be a factor in others with food intolerance – even those who are not overtly sensitive to everyday chemicals. It is possible that chemicals in food and drinking water affect the gut wall, making it more leaky – there might be no obvious effect from the chemicals alone, but they could create the right conditions for food intolerance.

Such chemical exposure might also play a part in true allergy. We have already seen that patients with food allergy are more likely to be enzyme deficient than those with no allergy or intolerance. And the incidence of certain allergies appears to be increasing – in fact, this is much better documented than the alleged rise in food intolerance, because doctors are agreed on how to diagnose allergic diseases. Eczema is one of the allergic problems that is steadily rising – and it is one that is quite often associated with food sensitivity. Whether chemical exposure is playing a part in this remains to be seen.

*310\180\8*

Food allergy generally begins in childhood, while food intolerance can begin at any time of life. Having said that, there is often no clear distinction between allergy and intolerance, especially in children. Those with proven allergies, such as asthma or eczema, may show other symptoms that most self-respecting allergists would have nothing to do with – hyperactivity, for example, or muscle aches. If these clear up along with the allergic symptoms when certain foods are withdrawn, then is it allergy or intolerance? To avoid the problem, we will use the term ‘food sensitivity’, to cover both allergy and intolerance.

Over the past ten years, doctors have begun to recognize just how many different childhood problems can be caused by food sensitivity. Colic, eczema, asthma, persistent runny nose, glue ear, headaches, migraine and even behavioural problems, have all been traced back to certain foods or food additives. These discoveries have a bittersweet taste for the many mothers who have been told by their doctors that they themselves were at the root of such problems – because they were over-anxious, inexperienced, nervy, over-indulgent or whatever. This sort of ‘diagnosis’ is usually based on minimal evidence and does untold harm to the self-confidence of mothers at a time when they most need help and support. Anxious, inexperienced mothers can be the source of their child’s mysterious health problems, of course, but there is increasing evidence that it is commonly something in the diet or the environment. There is also evidence that children who show food sensitivity in their early years are more likely to develop other health problems later, often continuing – or reappearing – in their adult lives. Helping these children to adapt to their environment is therefore important, and putting their symptoms down to poor mothering, without any evidence, is irresponsible and potentially damaging.

It is now believed that babies can be sensitized to food even before they are born, because a few food molecules, from food the mother eats, can reach the baby in her womb. More importantly, food molecules get into the mother’s breast milk, and babies that are exclusively breast-fed can be ill because of the sort of food the mother is eating. Although sensitivity to cow’s milk is by far the most common problem in babies and children, all sorts of other foods have been implicated. These relatively recent discoveries have meant that food sensitivity can now be recognized and dealt with far more effectively. They have also suggested ways in which parents can reduce the risk of food sensitivity in their children.

*260\180\8*

For a young man of 22, Danny had a surprising number of health problems. Afraid of losing his job as a trainee hotel manager, he pretended not to be as unwell as he really was. He only consulted the doctor when the red, itchy bumps that covered his skin (nettle-rash) became unbearable. It was with great reluctance that he admitted his other symptoms – regular bouts of indigestion and diarrhoea, aches in his joints, headaches and extreme fatigue. There was also some eczema and hay-fever, both of which he had suffered from as a child. Skin-prick tests showed that he was sensitive to grass pollen and cat fur, but not to any foods. Nevertheless, the doctor decided to try Danny on an elimination diet, excluding most of the foods that he usually ate. Within six days he returned to the surgery looking very pleased. He reported that his nettle-rash was gone, along with his

headaches, joint pains and digestive problems. He felt far more fit and energetic as well. Under the doctor’s supervision, he then reintroduced foods one at a time. Wheat, milk, eggs, tomatoes and oranges caused the problems. These brought on urticaria within a few hours, with tiredness, headache and aching joints later. Danny can avoid these foods most of the time and has remained well. His eczema also cleared up after a while, and his hay-fever is less troublesome than before. This sort of case is interesting because the diet apparently helps with symptoms that are thought to be due to allergic reactions, such as urticaria and eczema, as well as clearing up symptoms like headache, diarrhoea and joint pain. There are many cases of this type on record, making it difficult to draw a sharp dividing line between food allergy and food intolerance.

*12\180\8*

“Nothing. That’s why you have to stay with me. That’s why you have to be my slave. You’re only something at all because you’re with me, who’s everything. Say, ‘You are everything, Master, and I am nothing.’”

“You are everything, Master, and I am nothing.”

“Now, do exactly as I say!”

“Yes, sir.”

“Unzip my fly. Unzip it right now.”

“Yes, sir.”

“Take it out.”

“Take out what, sir?”

“Don’t act stupid. Take it out.”

“Your cock, sir?”

“Don’t say that word.”

“Yes, sir.”

“Fondle it.”

“Yes, sir.”

“That’s right, keep fondling it.” “Yes, sir. Does it feel good, sir?”

“Don’t ask questions. I didn’t say you could ask me questions.”

“Sorry, sir.”

“Now, take off your clothes. Leave on your panties. Follow my instructions exactly.” “Yes, sir.”

“That’s right. Take them off.” “Yes, sir.”

“But leave on your panties, because I don’t want to see your dirty hole.” “Yes, sir.”

*117/196/1*

Players: Prostitute and John.

Activist: Wife, without husband’s foreknowledge, or both. Setting: Home or hotel.

Aim: Arouse wife’s sexual passion by appealing to her prostitute fantasies, while prodding husband out of his oral (“Take care of me, please!“) passivity.

Game Plan: If the wife is up to it, she may want to spring this game on her unsuspecting husband some night at home or away during a vacation. Or, they may both participate in setting up and playing the game. If the wife activates the game on her own, it is more likely not only to plug in to her whore fantasies, but also to appeal to the angry, proud aspect of her character.

One night while the husband is either home or in a rental room alone, the wife rings the doorbell several times, insistently. He opens it to find a quite different wife than he has ever seen before. She is dressed for the part, with hair all askew, oodles of red lipstick, eyeliner, rouge, a low-cut neckline, a miniskirt, net stockings, and high-heeled shoes. She smiles seductively and slithers saucily across the room.

*92/196/1*